Presentation
This patient underwent upper endoscopy for dysphagia which showed upper esophageal varices and hence a CT scan of the chest was ordered.
Patient Data
Isolated upper esophageal varix. None in the lower esophagus.
CT scan of the chest was ordered.
SVC stenosis is noted. Collaterals noted via collateral branches to the intercostal and inferior phrenic vein. These are systemic to systemic collaterals and not systemic to portal collaterals.
SVC stenosis (blue arrow) is noted. Collaterals noted (red arrows) via collateral branches to the intercostal and inferior phrenic vein.
1. See the collaterals via thyroidal branches like the CT.
2. SVC stenosis close to RA junction.
3. Post ballooning there is no significant stenosis.
SVC stenosis close to RA junction (blue arrow).
Case Discussion
The patient previously had a right-sided Port-A-Cath. The catheter had been removed for a clot or stenosis seen on CT neck a few months prior in a different hospital. This history is important as a radiologist sees the collaterals very often and would not call it a varix unless that history is provided in detail.
Downhill esophageal varix secondary to SVC stenosis after long-standing catheter placement like a Port-A-Cath or dialysis catheter is underreported by radiologists,
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